Nyumbani is an outreach to HIV infected and affected orphans and operates through 3 programs: Nyumbani Home caring for 109 HIV+ orphans Lea Toto

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1 Children of God Relief Institute (COGRI) Nyumbani KENYA Nyumbani is an outreach to HIV infected and affected orphans and operates through 3 programs: Nyumbani Home caring for 109 HIV+ orphans Lea Toto Community-based Care Program serving approx 3,000 HIV+ children living with a caregiver, operating in 6 Centres in the informal settlements surrounding Nairobi Nyumbani Village serving 582 orphans and 57 grandparents in a blended family style

2 Programs supported by PEPFAR - Lea Toto Lea Toto is almost entirely funded by PEPFAR and offers Holistic medical care including ART with monitoring of CD4, viral load and, currently, limited resistance testing, with assistance for opportunistic infections medicines from Medicines for Humanity Counselling support to caregivers and children including disclosure, and caregiver training

3 Cont.. Nutritional support assisted by World Food Program (WFP) and Concern Worldwide Social support including limited educational support assisted by 2 other donors Organizational/Community capacity building Prevention including HCT/DCT

4 History of USG support of the Lea Toto Program USAID funding managed by CRS September 1999 April $ 200,000 to reach 200 children USAID funding managed by CRS May August $ 500,000 to reach 1,000 children (approx $250,000 utilised) USAID direct management Agreement August th June, $750,000 to reach 1,000 children

5 History of USG funding of Lea Toto USAID Agreement July 2006 February $ 2,500,000 to reach 3,000 children USAID Agreement March 2009 February $ 6,000,000 to reach 8,500 children and 40,000 family members

6 USG support of Nyumbani Village Special grant of $500, th October, st December, 2008, to assist in the setting up of the Village Home-care services, including medical care 1 st January, st December, 2012, USAID Agreement for $2,000,000 to reach 1,000 children and 100 grandparents

7 USAID/PEPFAR guidance on implementation and evaluation IMPLEMENTATION Quarterly meetings Technical comments on proposals Continuous technical guidance from AOTR Bi-Annual Partners Meetings Pre-award meetings Mapping survey help for extension of Lea Toto services EVALUATION Partners' Meetings on Monitoring and Evaluation (M & E) Trainings on M & E Lea Toto Evaluation 2006 Evaluation of Village in process

8 Sources of guidance that drive data collection/evaluation COGRI Strategic Plan PEPFAR requirements National AIDS/STIs Control Program (NASCOP) The Kenya National AIDS Strategic Plan 111 (KNASP 111) 2009/ /2013 Children's Act 2001 Other donor requirements WFP Concern Worldwide Medicines for Humanity Education sponsors

9 COGRI STRATEGIC PLAN COGRI VISION Sustainable communities for children infected and affected by the HIV pandemic, inspired by Christian compassion COGRI MISSION To provide quality comprehensive care and support to HIV infected and affected children, their families and communities in a sustainable manner

10 COGRI STRATEGIC THEMES AND OBJECTIVES Holistic development, quality optimum care and re-integration of children Institutional strengthening, networking and capacity building Resource mobilization, lobbying, advocacy and self-sustainability Monitoring and Evaluation Research and prevention of HIV/AIDS Promoting COGRI's image and stakeholder satisfaction

11 USAID/PEPFAR Objectives Lea Toto Care, Nutritional support and Counselling: To facilitate the provision of high quality clinical, nursing and counselling service to 8,500 HIV+ children and 40,000 family members Social Support: To provide a package of social support services to at least 70% Organizational Capacity-Building of Lea Toto Community Capacity-Building: To improve the ability of local communities to prioritize and advocate for the needs of HIV+ children Prevention: To empower the communities to negotiate, support, maintain safe behaviours

12 USAID/PEPFAR Objectives Nyumbani Village To provide holistic social services to 100 Nyumbani Village families:1,000 children,100 grandparents To expand the services of the Health Care Centre to residents of the outside communities to reach 5,000 adults and 3,000 children To expand the capacity of the Vocational Training Centre To expand the Sustainability Program in order to increase food production, nutrition and agro-income security To establish a community-managed revolving microcredit service To continue to work with local leaders in the developing of the surrounding communities

13 Objectives of Other Donors WFP: Sustainability of families through development of income-generating capacity Concern Worldwide: Early detection of malnourished children, Ready To Use Therapeutic Food (RUTF) support of severely malnourished children and training of caregivers Medicines for Humanity: Availability of opportunistic Infections medicines to the underprivileged, and training in health care Education Donors: Education: the Gateway out of poverty

14 History of Data Base development From the beginning data collection has been part of COGRI's operations Data collection in the early days concentrated on social services and was laborious The Nyumbani Diagnostic Laboratory was the first to develop an electronic database system In 2007, the Lea Toto program engaged a consultant to develop a comprehensive electronic data management system We are now at Phase 2: Data extraction reports

15 Database Layout Staff sign-in Form Create new user form Evaluation project forms? General client ID & contact information Medical intake form Social work Intake form Counselling intake form Training form Nutrition visit form Nursing per visit form Social per visit form Counselling per visit Referral Lab & Death Pharmacy radiology

16 Functions of the Lea Toto Data Management System Real time data collection of day to day clinical, social support and counselling activities Data 'cleaning' Secure storage Program monitoring Program evaluation

17 Feasibility of data collection for reporting The Lea Toto database covers a broader spectrum of indicators than those required by PEPFAR broader than Child Service Index (CSI) Detailed monthly reports are prepared for discussion and evaluation at different levels of management: Centre level: Centre Administrators with team weekly - Multidisciplinary Meetings (MDT) Middle management level: Centre Administrators with Program Manager bi-monthly Executive Director level with Program Managers monthly

18 Feasibility of data collection for evaluation There are different fora where ongoing program evaluation takes place: The three levels of management Monthly medical meeting at Executive Director level with medical doctors, clinical officers, pharmacist, chief nutritionist Professional Meetings at departmental level Medicines & Therapeutic Committee meetings Technical evaluation with consultants

19 Client Enrollment. Client category April May June July August Sept October November Active ,987 2, Deceased transfer out Exits Over 18yrs Retested negative Lost to follow-up Declined Cumulative 5,

20 ARV Treatment LOCATION ACTIVE DECEASED LOST TO FOLLOW UP TRANSFER STOPPED DECLINED Kawangware Kangemi Kariobangi Kibera Dandora Mukuru Total

21 Successes Reports based on data provide direction regarding ongoing development and enhancing of the services: Mortality rates led to lobbying for ART, early intervention with malnourished children (RUTF) and to opening of Respite Centre Increase in referrals out of the program have invited examination of causes Increase in client enrollment invite evaluation to see if additional staff are required or need to open a new Centre

22 SUCCESSES Clinical and laboratory data has highlighted the need for resistance testing Increased client numbers have highlighted the need to involve local leadership more so as to mobilise local resources to supplement donor aid Development of the database has eliminated 'ghost' clients since every client has an unique ID Extraction of data per Centre allows for evaluation at Centre level and Inter-Centre level

23 INFANT TESTING (PCR TEST) TOTAL TESTS DONE SINCE MARCH 2007 SEPT 2009: Cumulative 6,137 Negatives results 4,940 Positive results 791 Pending results 406 This invites more emphasis on PMTCT

24 Challenges Training of staff during the initial stages of the database system Heavy caseloads can lead to incomplete filling of forms The possibility of double enrolment in cases where different partners are offering services in the same area Different interpretations of indicators between different partners before Next Generation indicators

25 Aerial View of Nyumbani Village, Kitui

26 Management at the Village Project Manager Homecare Depart. Sustainability Depart. Hotcourses School Polytechnic Clinic

27 Nyumbani Village Data Management System Data Management in Nyumbani Village is in the early stages of development Currently each department has its own rudimentary database PEPFAR indicators are monitored separately

28 Nyumbani Village PEPFAR Indicators # of CT Service Outlets Palliative care TB/HIV # of Service Outlets providing HIVrelated PC (incl TB/HIV) # of individuals provided with HIVrelated PC (incl TB/HIV) CT # Clients receiving CT and test results # Individuals trained in CT # of individuals trained to provide HIV PC (incl TB/HIV) Treatment # of Service Outlets # of Current individuals on ARVs # of individuals newly initiating ART Cumulative # of people on ARVs OVC # of new OVCs served by the program within the reporting period Persons Trained # of Individuals trained on delivery of ART # of PMTCT Service Outlets Palliative care HBC # of Service Outlets providing HIVrelated PC (excl TB/HIV) # of individuals provided with HIVrelated PC (excl TB/HIV) # Clients receiving prenatal & antenatal care including PMTCT # Individuals trained in PMTCT # of individuals trained to provide HIV PC (excl TB/HIV) PMTCT